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3:38 am

Sun September 23, 2012

At School, Overweight Children Carry A Heavy Burden

One in three children in the United States is overweight or obese. Significant numbers of those young people are grappling with health problems like heart disease, high blood pressure and diabetes.

Those conditions can be difficult for children to manage in any setting, but they can pose particular challenges for children during the school day.

Dr. Yolandra Hancock used to be an elementary school teacher, and it shows. She's patient, encouraging and has an endearing way of ending her sentences with "my love" and "my sweet."

Her patients include a 13-year-old who weighs 400 pounds; a child whose teeth are so rotted she can't bite into carrots; and many preteens who are diabetic. Today, Hancock is examining Derek Lyles, 13. He's 4 feet 11 inches and weighs 256 pounds.

"When we look at his body mass index, which is how well his weight and height balance out, his BMI today is 46.7," Hancock says. "For an adult male, we like to see a BMI of 30 or less."

Hancock is also troubled by dark patches of skin around Derek's neck.

"When little ones, especially around the back of the neck, have that sort of thick, almost velvety appearance to their neck, it means that their bodies are becoming less sensitive to insulin," she says.

Back-to-school checkups for patients like Derek mean lots of follow-up work for Hancock. Their belly fat pushes down on their bladders, so she'll have to write notes to principals, asking that her patients be allowed to go to the bathroom frequently. She must also draft requests to excuse children whose sleep apnea makes them appear drowsy in class, or whose joints hurt as they walk between classes.

Practical Challenges, For Kids And Schools

These accommodations also mean more work for schools, says Camille Wheeler, a nurse at Bell Multicultural High School in Washington, D.C.

"It's a lot. It really is," Wheeler says. "It takes a lot for the student, for the nurse, the parent and the school. Especially the school. Because the majority of the time the students are here, you know?"

Wheeler says it's not unusual for a child to arrive at school at 8 a.m. and depart at 6 p.m., depending on a family's aftercare arrangements.

"That's a large chunk of their time," she says.

On a recent afternoon, Wheeler is thumbing through stacks of paper, racing to process students' health information.

"I have a whole stack here of many, many health certificates, dental forms, health records," she says. "It's about well over 200 forms in here, and I'm getting them daily."

Many of the forms are related to obesity. Children with diabetes need midmorning snacks. Some are on special diets and some need medication. All this means time away from the classroom.

"It may not be in the forefront, like a broken bone for example, but it's there and it affects the students every day," says Shirley Schantz, nursing education director for the National Association of School Nurses.

Schantz says that nurses from across the country are increasingly calling her organization, asking for guidance on how to deal with childhood obesity in schools — even preschools.

"They see students that can't walk upstairs," she says. "They see students that are absent because they're overweight or obese, [who] don't want to go to physical education."

The physical aspects of living with obesity can be difficult enough for a child. But there's an emotional toll, as well. Bullying is a common problem for obese kids. Derek says other students often called him fat in middle school.

Taking A Toll On Learning

All these challenges can also affect learning. Dr. Hancock says there is evidence that children who are obese score less well on standardized tests and basic classroom tests.

"Some researchers believe that there may be something physiologically that's affecting the child's ability to learn," Bell says. "Others believe, because of self-esteem issues and bullying, it makes them less eager to attend school and participate in school activities."

Derek wants to lose weight so he can "walk fast like other kids." And he really wants to start playing football again this year.

"During training camp, I couldn't do most of the, like, exercise that other people was doing," Derek says. "I just couldn't do it."

For many obese children, even maintaining their weight when they're not in school is challenging. This summer, Derek could eat whenever he wanted, and the fridge was always stocked with food. At school, he says, he ate cereal or a muffin for breakfast. But over the summer, he often ate sausage and eggs. The pounds piled on.

Hancock hopes eating meals at school will help Derek get his weight under control. She embraces Derek as she says goodbye.

"All right, handsome, give me some hugs," Hancock says, embracing Derek. "I have faith you'll be able to make changes, because you've done this before."

As Hancock reminds her young patient, it's a brand new school year — an opportunity to start fresh.

This is WEEKEND EDITION from NPR News. I'm Linda Wertheimer. In the United States, one in every three children is overweight or obese. Significant numbers face health problems, such as heart disease, high blood pressure and diabetes. In addition to medical issues, overweight children face a host of challenges in school, as Kavitha Cardoza of member station WAMU in Washington reports.

KAVITHA CARDOZA, BYLINE: Dr. Yolandra Hancock used to be an elementary school teacher and it shows. She's patient, encouraging and has an endearing way of ending her sentences with my love and my sweet. Her patients include a 13-year-old who weighs 400 pounds, a child whose teeth are so rotted from her diet she can't bite into carrots and many preteens who are diabetic. Today, Hancock is examining 13-year-old Derek Lyles. He's four-feet-11-inches tall and weighs 256 pounds.

HANCOCK: And when we look at his body mass index, which is how well his weight and height balance out, his BMI today is 46.7. So, for an adult male, we like to see a BMI of 30 or less.

HANCOCK: When little ones, especially around the back of the neck, have that sort of thick, almost velvety appearance to their neck, it means that their bodies are becoming less sensitive to insulin.

CARDOZA: Back-to-school checkups for patients like Derek mean lots of follow-up work for Hancock. She'll have to write notes to principals asking that her patients be allowed to go to the bathroom when they need to - their belly fat pushes down on their bladders. Also, requests to excuse children who appear drowsy in class because of sleep apnea and those whose joints hurt as they walk between classes. And that means much more work for schools.

CAMILLE WHEELER: It's a lot, it really is, it's really a lot.

CARDOZA: Camille Wheeler is a nurse at Bell Multicultural High School.

WHEELER: It takes a lot for the student, for the nurse, the parent and the school - especially the school. Because the majority of the time the students are here, you know? Anywhere from, like, 8 o'clock in the morning to sometimes, depending on aftercare, 6 o'clock at night. That's a large chunk of their time.

CARDOZA: She's racing to process student's information.

(SOUNDBITE OF PAPERS SHUFFLING)

WHEELER: Well, I have a whole stack here of many, many health certificates, dental forms, health records. This stack is probably, wow, it's about well over 200 forms in here and I'm getting them daily.

CARDOZA: Many of the forms are to do with obesity. Children with diabetes need mid-morning snacks, some are on special diets, some need medication. All this means time away from the classroom. Shirley Schantz is with the National Association of School Nurses.

SHIRLEY SCHANTZ: It may not be in the forefront like a broken bone for example, but it's there and it affects the students every day.

CARDOZA: She says across the country there are increasing calls from nurses to her organization asking for guidance on how to deal with childhood obesity in schools and preschools.

SCHANTZ: They see students that can't walk upstairs. They see students that are absent because they're overweight or obese that don't want to go to physical education.

CARDOZA: The physical aspect of obesity is one obstacle students face. Bullying is another. Derek Lyles says that happened often to him in middle school.

DEREK LYLES: Like calling me fat and stuff.

CARDOZA: And this can affect learning. Dr. Hancock says there is evidence children who are obese score less well on standardized tests and basic classroom tests.

HANCOCK: Some researchers believe that there may be something physiologically that's affecting the child's ability to learn. Others believe because of self-esteem issues and bullying, it makes them less eager to attend school and participate in school activities.

CARDOZA: Derek wants to lose weight so he can walk fast like other kids. And he really wants to start playing football again this year.

LYLES: During training camp, I couldn't do most of the, like, exercise that other people was doing. I just couldn't do it.

CARDOZA: For children of unhealthy weights, even maintaining their weight when they're not in school is challenging. This summer, Derek could eat whenever he wanted and the fridge was always stocked with food. So, the pounds piled on.

HANCOCK: What kind of breakfast are you eating at home?

LYLES: Sometimes eggs and sausage.

HANCOCK: And at school, what are you usually eating?

LYLES: Cereal or a muffin.

CARDOZA: Hancock's hoping eating meals at school will help Derek get his weight under control.

HANCOCK: All right, handsome, give me some hugs. I have faith that you'll be able to make changes 'cause you've done this before. OK?

CARDOZA: As Hancock reminds her young 13-year-old patient, it's a brand new school year. For NPR News in Washington, D.C., I'm Kavitha Cardoza. Transcript provided by NPR, Copyright NPR.